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TITLE OF BILL: An act to amend the public health law, in relation to requiring immunization against human papillomavirus (HPV)

PURPOSE OR GENERAL IDEA OF BILL:

To ensure that immunization against HPV be administered to children in New York State in the same manner and according to the same time schedule that other immunizations are currently administered

SUMMARY OF SPECIFIC PROVISIONS:

Section one amends the section heading and subdivisions 2, 3, 5, and 6 of section 2164 of the public health law, as amended by chapter 169 of the laws of 2006, subdivision 2 as separately amended by chapter 506 of the laws of 2006, by adding human papillomavirus (HPV) to the list of required immunizing agents, such as those against poliomyelitis, mumps and measles, to be administered to children in this state. Section one also adds the HPV vaccine to the list of vaccines for which: a booster is required; a person in parental relationship to a child shall request a vaccine if not previously administered; a health practitioner who administers such immunizing agents shall give a certificate of immunization to the person in parental relation to a child who has been vaccinated; a person in parental relation shall be notified by a principal, teacher, owner or person in charge of the school that the school has not received a certificate of immunization or other acceptable evidence of the child's immunization. A form shall be provided by the school to a person in parental relationship to a child not yet vaccinated which allows such person to either state a valid reason for withholding consent to immunize such child or to give permission to the school to immunize the child. The law currently permits a religious exemption to mandated immunizations.

Section two amends paragraph (a) of subdivision 7 of section 2164 of the public health law, as amended by chapter 189 of the laws of 2006, by adding HPV to the list of immunizations for which a certificate of immunization is required by a school in order to allow a child to attend such school in excess of fourteen days. If a student is transferring from out-of-state or from another country and can show a good faith effort to get the certificate or other evidence of immunization, the time period may be extended to thirty days.

Section three amends the opening paragraph of subdivision 8-a of section 2164 of the public health law, as amended by chapter 189 of the laws of 2006, by adding HPV to the list of required immunizing agents for which a certificate of immunization is required in relation to preventing a child from attending school.

Section four amends paragraph (a) of subdivision 1 of section 613 of the public health law, as amended by chapter 36 of the laws of 2010, by adding HPV to the list of communicable diseases against which the commissioner of health shall develop and supervise the execution of a program of immunization, surveillance and testing in order to raise to the highest reasonable level the immunity of children in the state.

Section five provides the effective date.

JUSTIFICATION:

Cervical cancer is the second-leading cancer among women worldwide, affecting an estimated 470,000 worldwide resulting in 233,000 deaths annually. In the United States, the American Cancer Society (ACS) estimates that approximately 11,150 cases of cervical cancer will be diagnosed this year and approximately 3,670 women will die from cervical cancer. The American College of Obstetricians and Gynecologists estimates that in New York approximately 1,000 women are newly diagnosed with invasive cervical cancer and approximately 300 women die from the disease.

According to ACS, 99.7% of all cervical cancer cases are linked to human papillomavirus (HPV). The types of HPV that cause cervical cancer are sexually transmitted. ACS estimates that at least 80% of sexually active women in the United States will have HPV by age 50, with most cases acquired soon after individuals have Sex for the first time. Guttmacher Policy Review, Fall 2006. While the majority of cases resolve on their own, for women whose body defenses are not sufficient to clear the virus, cervical cancer can develop later in life (it can take up to 20 years for an HPV infection to cause cervical cancer).

A vaccine against the types of linked to most cases of cervical cancer, Gardasil, was approved last year by the United States Food and Drug Administration. The Centers of Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) recommended the routine vaccination of girls 11-12 years of age, but noted that the vaccine can be given to girls as young as 9 up to age 26. When CDC has recommended the vaccination of school-age children, New York adds such recommended vaccination to the list of vaccinations required for school entry.

Gardasil is shown to protect against two types of HPV that cause about 70% of cervical cancers and two other types of HPV that cause 90% of genital warts. The vaccine is given as a series of three shots over a period of six months. Another vaccine against HPV, Cervarix, was approved by the FDA in 2009.

Cervical cancer screening, through Pap tests and other detection technologies, together with the new vaccine now make cervical cancer one of the most preventable forms of cancers. Further, vaccination against HPV has the potential to significantly reduce cervical cancer incidence and mortality within our underserved populations - poor and rural communities and black and Hispanic communities, which are disproportionately affected by cervical cancer. In 2006, ACS estimated that more than half of the women in the United States diagnosed with cervical cancer had not had a Pap test in the last three years. These women are disproportionately low income, black and Hispanic who lacked access to affordable health services.

The vaccine is most effective when given to individuals before they are infected with HPV through sexual contact. ACIP therefore recommends that females should be vaccinated before sexual activity. To significantly reduce cervical cancer deaths in this country and the world, it is necessary to achieve near-universal vaccination of girls and young women prior to sexual activity. The most effective way to achieve rapid and widespread vaccination, as suggested by the

Guttmacher Institute, is by requiring children to be vaccinated prior to attending school. School-based immunization will also help to close racial, ethnic and socioeconomic gaps in immunization rates. Because many individuals have no health insurance coverage or access to affordable care, a school vaccination program will facilitate protecting individuals who are or may potentially become disconnected from health care services.

By requiring vaccination of girls at an early age, before they have engaged in sexual activity and before they have left school, we have a greater chance of preventing cervical cancer. ACS reports that surveys of teens in the United States show that almost one quarter of them have had sex by the age of 15 and 7096 have had sex by age 18. And, according to the Guttmacher Institute, school dropout rates begin to increase as early as age 13. Middle school may therefore be viewed as "the last public health gate that an entire age-group of individuals pass through together-regardless of race, ethnicity or socio-economic status." Guttmacher Policy Review, Fall 2006. This bill will leave to the department of health to determine the age at which girls will be required to be vaccinated in light of ACIP recommendations.

Currently, the cost of the vaccine is covered by Medicaid and Medicaid managed care plans, Child Health Plus and Family Health Plus. The federal al Vaccines for Children program covers the vaccination of eligible girls under age 18.

$1.5 million was included in the governor's budget proposal in 2009 to promote and expand access to the vaccine for low-income teens and women. Texas recently became the first state to require vaccination of school girls ages 11 and 12 against HPV and legislation requiring vaccination in the schools is currently being considered in 18 other states and the District of Columbia.

Minimal to the state, offset by future healthcare costs related to the treatment of cervical cancer.

EFFECTIVE DATE:

This act shall take effect on the first of September next succeeding the date on which it shall have become a law; provided, however, that sections one, two and three of this act shall apply only to children born on or after January 1, 1996.

Text

STATE OF NEW YORK
________________________________________________________________________
7315
IN SENATE
May 12, 2014
___________

Introduced by Sen. HOYLMAN -- read twice and ordered printed, and when
printed to be committed to the Committee on Health
AN ACT to amend the public health law, in relation to requiring immuni-
zation against human papillomavirus (HPV)
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The section heading and subdivisions 2, 3, 5 and 6 of
section 2164 of the public health law, as amended by chapter 189 of the
laws of 2006 and subdivision 2 as separately amended by chapter 506 of
the laws of 2006, are amended to read as follows:
Definitions; immunization against poliomyelitis, mumps, measles,
diphtheria, rubella, varicella, HUMAN PAPILLOMAVIRUS (HPV), Haemophilus
influenzae type b (Hib), pertussis, tetanus, pneumococcal disease, and
hepatitis B.
2. a. Every person in parental relation to a child in this state shall
have administered to such child an adequate dose or doses of an immuniz-
ing agent against poliomyelitis, mumps, measles, diphtheria, rubella,
varicella, HUMAN PAPILLOMAVIRUS (HPV), Haemophilus influenzae type b
(Hib), pertussis, tetanus, pneumococcal disease, and hepatitis B, which
meets the standards approved by the United States public health service
for such biological products, and which is approved by the department
under such conditions as may be specified by the public health council.
b. Every person in parental relation to a child in this state born on
or after January first, nineteen hundred ninety-four and entering sixth
grade or a comparable age level special education program with an unas-
signed grade on or after September first, two thousand seven, shall have
administered to such child a booster immunization containing diphtheria
and tetanus toxoids, [and] an acellular pertussis vaccine, AND A HUMAN
PAPILLOMAVIRUS (HPV) VACCINE, which meets the standards approved by the
United States public health service for such biological products, and
which is approved by the department under such conditions as may be
specified by the public health council.
3. The person in parental relation to any such child who has not
previously received such immunization shall present the child to a

EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04901-03-4

S. 7315 2

health practitioner and request such health practitioner to administer
the necessary immunization against poliomyelitis, mumps, measles,
diphtheria, Haemophilus influenzae type b (Hib), rubella, varicella,
HUMAN PAPILLOMAVIRUS (HPV), pertussis, tetanus, pneumococcal disease,
and hepatitis B as provided in subdivision two of this section.
5. The health practitioner who administers such immunizing agent
against poliomyelitis, mumps, measles, diphtheria, Haemophilus influen-
zae type b (Hib), rubella, varicella, HUMAN PAPILLOMAVIRUS (HPV),
pertussis, tetanus, pneumococcal disease, and hepatitis B to any such
child shall give a certificate of such immunization to the person in
parental relation to such child.
6. In the event that a person in parental relation to a child makes
application for admission of such child to a school or has a child
attending school and there exists no certificate or other acceptable
evidence of the child's immunization against poliomyelitis, mumps,
measles, diphtheria, rubella, varicella, HUMAN PAPILLOMAVIRUS (HPV),
hepatitis B, pertussis, tetanus, and, where applicable, Haemophilus
influenzae type b (Hib) and pneumococcal disease, the principal, teach-
er, owner or person in charge of the school shall inform such person of
the necessity to have the child immunized, that such immunization may be
administered by any health practitioner, or that the child may be immun-
ized without charge by the health officer in the county where the child
resides, if such person executes a consent therefor. In the event that
such person does not wish to select a health practitioner to administer
the immunization, he or she shall be provided with a form which shall
give notice that as a prerequisite to processing the application for
admission to, or for continued attendance at, the school such person
shall state a valid reason for withholding consent or consent shall be
given for immunization to be administered by a health officer in the
public employ, or by a school physician or nurse. The form shall provide
for the execution of a consent by such person and it shall also state
that such person need not execute such consent if subdivision eight or
nine of this section apply to such child.
S 2. Paragraph (a) of subdivision 7 of section 2164 of the public
health law, as amended by chapter 189 of the laws of 2006, is amended to
read as follows:
(a) No principal, teacher, owner or person in charge of a school shall
permit any child to be admitted to such school, or to attend such
school, in excess of fourteen days, without the certificate provided for
in subdivision five of this section or some other acceptable evidence of
the child's immunization against poliomyelitis, mumps, measles, diphthe-
ria, rubella, varicella, HUMAN PAPILLOMAVIRUS (HPV), hepatitis B,
pertussis, tetanus, and, where applicable, Haemophilus influenzae type b
(Hib) and pneumococcal disease; provided, however, such fourteen day
period may be extended to not more than thirty days for an individual
student by the appropriate principal, teacher, owner or other person in
charge where such student is transferring from out-of-state or from
another country and can show a good faith effort to get the necessary
certification or other evidence of immunization.
S 3. The opening paragraph of subdivision 8-a of section 2164 of the
public health law, as amended by chapter 189 of the laws of 2006, is
amended to read as follows:
Whenever a child has been refused admission to, or continued attend-
ance at, a school as provided for in subdivision seven of this section
because there exists no certificate provided for in subdivision five of
this section or other acceptable evidence of the child's immunization

S. 7315 3

against poliomyelitis, mumps, measles, diphtheria, rubella, varicella,
HUMAN PAPILLOMAVIRUS (HPV), hepatitis B, pertussis, tetanus, and, where
applicable, Haemophilus influenzae type b (Hib) and pneumococcal
disease, the principal, teacher, owner or person in charge of the school
shall:
S 4. Paragraph (a) of subdivision 1 of section 613 of the public
health law, as amended by section 24 of part E of chapter 56 of the laws
of 2013, is amended to read as follows:
(a) The commissioner shall develop and supervise the execution of a
program of immunization, surveillance and testing, to raise to the high-
est reasonable level the immunity of the children of the state against
communicable diseases including, but not limited to, influenza, poliom-
yelitis, measles, mumps, rubella, haemophilus influenzae type b (Hib),
diphtheria, pertussis, tetanus, varicella, HUMAN PAPILLOMAVIRUS (HPV),
hepatitis B, pneumococcal disease, and the immunity of adults of the
state against diseases identified by the commissioner, including but not
limited to influenza, smallpox, hepatitis and such other diseases as the
commissioner may designate through regulation. Municipalities in the
state shall maintain local programs of immunization to raise the immuni-
ty of the children and adults of each municipality to the highest
reasonable level, in accordance with an application for state aid
submitted by the municipality and approved by the commissioner. Such
programs shall include assurance of provision of vaccine, serological
testing of individuals and educational efforts to inform health care
providers and target populations or their parents, if they are minors,
of the facts relative to these diseases and immunizations to prevent
their occurrence.
S 5. This act shall take effect on the first of September next
succeeding the date on which it shall have become a law; provided,
however, that sections one, two and three of this act shall apply only
to children born on or after January 1, 1996.

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